骨关节炎课件.ppt

至今仍没有一种药物证明能阻止、延缓、逆转OA的病理学改变。 ----《临床药物治疗学》 治疗目的：减轻症状、改善关节功能、减少致残。 ----《内科学》 * 2014-3-20 Initial treatment of noninflammatory OA with acetaminophen（ APAP） NSAIDs if APAP is inadequate or inflammatory OA is present Topical NSAIDs or capsaicin as alternative to oral NSAIDs or APAP Intraarticular glucocorticoids if NSAIDs and APAP are insufficient Diagnostic reassessment for recurring joint swelling or inflammation We do not use glucosamine or chondroitin compounds because of insufficient evidence of clinically meaningful benefit. a six-month trial to determine if there is adequate symptom relief to justify continued therapy. * 2014-3-20 Resistant to initial pharmacotherapy： ●Opioid analgesics ●Intraarticular hyaluronans ●Glucosamine and chondroitin compounds ●Other agents, including colchicine * 2014-3-20 Paracetamol：mild to moderate pain that is intermittent and usually related to activity。 Regular release: 325-650 mg every 4-6 hours or 1000 mg 3-4 times daily (maximum: 4 g daily 8#)。 Patients with persistent symptoms advise regular use at doses of up to 3 g/day 6#。 Max 2 g/day 4# in older adults, patients at risk for hepatotoxicity (eg, regular alcohol use, malnourished) or with organ dysfunction. * 2014-3-20 There is no convincing evidence that any of the available NSAIDs is more effective than any other for OA of the knee or hip. A short- to medium-acting NSAID：preferably naproxen，ibuprofen Two to four weeks to evaluate the efficacy of a given NSAID because of the delay in achieving an antiinflammatory effect. The dose of the NSAID should be gradually increased if there is inadequate control of symptoms with the initial dose, toward the maximum for that drug. If one NSAID is not effective after two to four weeks on a maximal dosage, then another should be tried, as individuals can respond variably to different NSAIDs . * 2014-3-20 The risk of gastrointestinal complications wa